4. Be Sure to Share this Update with CNMs Who
are not yet ACNM members

State Issues

1. Proposed Collaborative Requirement Rules in
Louisiana

2. Change in Payments for Early Elective Delivery
in Montana

Federal Issues

1. ACNM Survey Looks at Marketplace Coverage for
Midwifery Services

On September 18, ACNM released the results of a survey
of health insurers that offer coverage through the Health Insurance
Marketplaces, asking them about the inclusion of midwives in plan provider
networks as well as coverage for midwifery services. The survey found the
following:

• Twenty percent of plans do not contract with CNMs to
include them in their provider networks, even though CNMs are licensed to
practice in all 50 states and the District of Columbia.

• Seventeen percent of plans do not cover primary care
services offered by CNMs, even though ACNM standards defining the scope of
practice for these providers, often incorporated by reference by state law,
include primary care services.

• Fourteen percent of plans indicated they impose
restrictions on CNM practice that conflict with their scope of practice under
state laws and regulations.

• Twenty-four percent of plans will not cover CNM
professional services provided in a birth center and 56% will not reimburse
CNMs for home birth services.

• Fifty percent of plans do not pay CNMs the same amount
paid to a physician when they perform and bill for the same service.

• Ten percent of plans that contract with CNMs do not list
them in their provider directories, making them invisible to potential and
current enrollees. Forty percent of plans listing CNMs in their provider
directories list them under the obstetrician-gynecologist category, which may
make it difficult for women searching for “midwives” to find them.

• Forty-seven percent of plans do not contract with birth
centers to cover facility costs associated with births in that setting, despite
studies showing very good outcomes and low costs associated with these
facilities.

• Among those contracting with birth centers, 18% do not
make a payment to the birth center for their services that is distinct from the
payment made to the professionals working therein.

• Eight percent of plans contracting with birth centers
indicated they did not list them in their provider directory.

The survey included questions about CMs, but because of a
very small sample size these results were generally not included in the report.
The survey also asked about inclusion of CPMs when the plan was located
in a state where CPMs are authorized to practice.

ACNM has issued an invitation to HHS to discuss the survey
results and their implications for the Department's efforts to ensure network
adequacy and the absence of discrimination among providers on the part of
health plans. We will report on the outcome of those discussions after
they occur.

2. ACNM Resource Helps Identify which State is the Best Place to
be a Midwife

So, where's the best place in the country to practice as a midwife? A slide
deck recently developed by ACNM can help you answer that question for
yourself. It provides data on where CNMs/CMs are located and how their
numbers compare to state populations, data on births attended by CNMs/CMs (and
CPMs) in each state, a set of slides on the impact of Medicaid as your most
important payer, and a quick look at variations in the cesarean rate. Finally,
there is some state by state salary information.

To help midwives who are newer in their careers, it also includes a very brief
overview of the Medicare physician fee schedule and some pointers on obtaining
an NPI and a Medicare number.

While the slide deck doesn't actually seek to answer the question of which
state is best, you can draw your own conclusions. I personally believe
that the folks choosing to practice in Arkansas and Louisiana are heros and
that midwives in Florida might be tempted to trade in the sunscreen for a snow
shovel and move to Alaska.

One option that the slide deck does not cover is that of the uniformed
services. If you join the military, they can help pay for your education
and you get to choose which state to get licensed in, so can select the most
advantageous one. Full practice authority is the norm in military
treatment facilities, so you don't have to worry about supervision or a
legalistic collaborative agreement, and hospital privileges are assured.
Perhaps best of all, a physician who is a captain has to salute a CNM who is a
major.

The National Governors Association (NGA) has released a report on
physician assistants (PAs) that has significant implications for efforts by the
PAs and other APRN groups to improve the regulatory environment under which
they work in the states.

The NGA concluded that state laws and regulations may not be
broad enough to encompass the professional competencies of PAs. In
addition, state statutes and regulations impose widely diverse restrictions on
physicians’ ability to delegate authority to PAs, which, in some instances, are
overly strict. The report goes on to say that Governors seeking to take full
advantage of the PA workforce in their states may review the laws and
regulations affecting the profession and consider actions to increase the
future supply of PAs.

The report on PAs builds on a previous
publication the NGA issued regarding NPs which concluded that states should
give consideration to reducing regulatory barriers to NP practice and ensuring
that they are appropriately reimbursed.

While these reports do not
mention CNMs, the fact that the NGA has taken such a strong stand on NP and PA
practice is encouraging. Many of the points made by the NGA about NPs and
PAs could also be made with regard to CNMs.

4. Be Sure to Share this Update with CNMs Who are not yet ACNM
members

Many CNMs are not members of ACNM and we want them to know
what the association is doing to support midwifery. Please forward this
note on to any you know who are not yet ACNM members. When they join,
these updates, as well as all of the other benefits of membership will come to
them automatically.

State Issues

1. Proposed Collaborative Requirement Rules in
Louisiana

The Louisiana affiliate and the national office have
submitted comments to the Board of Medical Examiners in opposition to proposed
rules governing the collaborative relationship between APRNs and physicians. If
adopted, the rules, among other things, would require APRNs to have a secondary
(back-up) collaborating physician and implement new “quality assurance”
standards, including mandatory monthly chart reviews. A public hearing is
scheduled for late September; ACNM will update members on the status of the
rules as new information becomes available.

2. Change in Payments for Early Elective
Delivery in Montana

On September 18, the Montana Department of Public Health and
Human Services adopted new rules that will decrease Medicaid payments to
physicians and advanced practice nurses for early elective deliveries (EED) by
disallowing the application of the maternity policy adjustor effective October
1. EED is defined in the new rules as “either a nonmedically necessary labor
induction or cesarean section that is performed prior to 39 weeks and 0/7 days
gestation.” The Department specifically cites to evidence that implementation
of a policy to decrease the rate of reimbursement decreases the number of EEDs
and improves neonatal outcome as their rationale for the new rule.

Should you have questions about these issues, please contact
Jesse Bushman, ACNM’s Director of Advocacy and Government Affairs at [email protected] or 240-485-1843.

Not an ACNM member? You can access all of the
member benefits, including receipt of every ACNM Policy Update, by joining
today.